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APPLICATION FOR SANITATION PERMIT Permit No. .. _�'_.... (Complete in Duplicate)Pell Date Issued --------_- Applica�ion is hereby made to the San Joaquin Local Health District for a permit to construct nd install the work herein described. This application is made in compliance with County �Ord��inance N 549. JOBADDRESS APL ATI ----/-- �_____ ---._1N_-_---- -- --- ---------- ---------------------------------------------------------------------------------------- I -------- Owne'r's Name Phone ---------------------•---- Address _:---------------------------------a-------------------------- ------ ----------------------------------------------- ---- -- -------- - Contrector's Name -------- � i~ ! Phone ___-. _-4__. --_-________ - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel n Other ❑ Number of living units:.-/--- Number of bedroom_____ Number of baths____ Lot size ___ Water Supply: Public system FrIc--ommunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ Previous Application Made: Yes ❑ No FA--'—New Construction: Yes Q��o ❑ TYP FT INSTALLATION AND SPECIFICATIONS: (No septic tank orcesspool permitted if public sewer is available within 200 feet.} Disance from ep ti Tan. ' Not of compartme tst-we _5szeance from fou datiLiquid d �M{ �I. a p-------- --u --------------^---__ ' Disposal Field. Distance from nearest well-A R DistancArVom1froundation_/__0.._____.Distance to nearest lot line____,.. Number of lines___.A----- __ __ ___ _ "Length of each line--__7X__r F_�--..Wiidth of trench___. _ _ /..__------------ Type of filter material-'--- :: - .___ �_Depth of filter material---_/ Total length_______. -�___ ________________ Seepage Pit: Distance to nearest,well________---__--___Distant rioim��foundation__74rr------. 'st nce to nearest lot lirie--- Number of pits--- ..--- ---Lining materialSize: Diameter___? n ' Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material---------- -------------.-_-____.___ ❑ Size: Diameter---------------------------- --------Deptli_-------------------------------------------------- Liquid Capacity----------------------------gals. �.. Privy: Distance from nearest well------------------------------------ ------------Distance from nearest building-------------------------.___------------- ❑ Distance to nearest lot line_.________.._.._________._ - Remodelingand/or repairing (descril5e):----- -------------------------------- --------------------------------------------------------- ------------------------- ----------•--------------•-•-- ---------------------------------------------------•------------------------------ ------ ------ ------•------•-----------------------------------------------------------------------•--------------------------=---------•---------------------------------------------------------------------------------------- - I hereby certify that 1 have prepared this application and t at the wor will be done in accordance with San Joaquin County ordinances, State laws, and rules%ar�td, rr'dquiafions of the SanyJoffluinH istrief. ' Seyatic Tank Service(Signed) = e Contractgy. Stocktan, Califor} - ---------------------------------- (T.ltle). ------------------- (Piot plan, showing size of lot, location of system in relation ts, etc., an be placed on reverse side). FOR DEPAAUENT USE ONLY APPLICATION ACCEPTED BY------ ------- ------ - ---- -- ------- ---------------------------------------- DATE.--- - REVIEWED BY----------------------------------------- ;, DATE- , -1 BUILDING PERMIT ISSUED---•---•-------- - -------------------------------------------------------------- DATE--- Alterations and/or reco menda 'ons:--------k ---- _ _ ------ ---- -------- ----- r -... _ r ----------------------------------- _ -----------•------------------- ----------------------------------- -- --------------- -------- FINAL INSPECTION BY: i .� bklh - _ .. } ..- --�-- � ----------- - � Date-_._ -----------------•---... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Sauth American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 4 E5-9-2M ; ' Revised W-2100